Coadministration of co-trimoxazole with sulfonylureas: Hypoglycemia events and pattern of use

Alai Tan, Holly M. Holmes, Yong Fang Kuo, Mukaila Raji, James Goodwin

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background. Coadministration of co-trimoxazole with sulfonylureas is reported to increase the risk of hypoglycemia. Methods. We identified a cohort of Medicare beneficiaries aged 66 years or older who took glyburide or glipizide for diabetes from a 5% national sample of Medicare Part D claims data in 2008 (n = 34,239). We tracked each participant's claims during 2008-2010 for a co-trimoxazole prescription and subsequent emergency room visits for hypoglycemia. Descriptive statistics and logistic regression modeling were used to evaluate hypoglycemia-related emergency room visits after coadministration of co-trimoxazole with sulfonylureas and its utilization patterns in older adults with diabetes. Results. Sulfonylureas users prescribed co-trimoxazole had a significant higher risk of emergency room visits for hypoglycemia, compared with those prescribed noninteracting antibiotics (odds ratio = 3.89, 95% confidence interval = 2.29-6.60 for glipizide and odds ratio = 3.78, 95% confidence interval = 1.81-7.90 for glyburide with co-trimoxazole, using amoxicillin as the reference). Co-trimoxazole was prescribed to 16.9% of those taking glyburide or glipizide during 2008-2010, varying from 4.0% to 35.9% across U.S. hospital referral regions. Patients with polypharmacy and with more prescribers were more likely to receive co-trimoxazole. Patients with an identifiable primary care physician had 20% lower odds of receiving a co-trimoxazole prescription. Hospital referral regions with more PCPs had lower rates of coadministration of the two drugs (r = -.26, p < 0.001). Conclusions. Coadministration of co-trimoxazole with sulfonylureas is associated with increased risk of hypoglycemia, compared with noninteracting antibiotics. Such coadministration is prevalent among older diabetic patients in the United States, especially in patients without an identifiable primary care physician.

Original languageEnglish (US)
Pages (from-to)247-254
Number of pages8
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume70
Issue number2
DOIs
StatePublished - Feb 1 2015

Fingerprint

Sulfamethoxazole Drug Combination Trimethoprim
Hypoglycemia
Glipizide
Glyburide
Hospital Emergency Service
Primary Care Physicians
Prescriptions
Referral and Consultation
Medicare Part D
Odds Ratio
Confidence Intervals
Anti-Bacterial Agents
Polypharmacy
Amoxicillin
Medicare
Logistic Models

Keywords

  • Diabetes
  • Drug-drug interaction
  • Hypoglycemia
  • Medicare
  • Older adults

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology

Cite this

@article{af545e6ae9a44c16870f8596d1d89762,
title = "Coadministration of co-trimoxazole with sulfonylureas: Hypoglycemia events and pattern of use",
abstract = "Background. Coadministration of co-trimoxazole with sulfonylureas is reported to increase the risk of hypoglycemia. Methods. We identified a cohort of Medicare beneficiaries aged 66 years or older who took glyburide or glipizide for diabetes from a 5{\%} national sample of Medicare Part D claims data in 2008 (n = 34,239). We tracked each participant's claims during 2008-2010 for a co-trimoxazole prescription and subsequent emergency room visits for hypoglycemia. Descriptive statistics and logistic regression modeling were used to evaluate hypoglycemia-related emergency room visits after coadministration of co-trimoxazole with sulfonylureas and its utilization patterns in older adults with diabetes. Results. Sulfonylureas users prescribed co-trimoxazole had a significant higher risk of emergency room visits for hypoglycemia, compared with those prescribed noninteracting antibiotics (odds ratio = 3.89, 95{\%} confidence interval = 2.29-6.60 for glipizide and odds ratio = 3.78, 95{\%} confidence interval = 1.81-7.90 for glyburide with co-trimoxazole, using amoxicillin as the reference). Co-trimoxazole was prescribed to 16.9{\%} of those taking glyburide or glipizide during 2008-2010, varying from 4.0{\%} to 35.9{\%} across U.S. hospital referral regions. Patients with polypharmacy and with more prescribers were more likely to receive co-trimoxazole. Patients with an identifiable primary care physician had 20{\%} lower odds of receiving a co-trimoxazole prescription. Hospital referral regions with more PCPs had lower rates of coadministration of the two drugs (r = -.26, p < 0.001). Conclusions. Coadministration of co-trimoxazole with sulfonylureas is associated with increased risk of hypoglycemia, compared with noninteracting antibiotics. Such coadministration is prevalent among older diabetic patients in the United States, especially in patients without an identifiable primary care physician.",
keywords = "Diabetes, Drug-drug interaction, Hypoglycemia, Medicare, Older adults",
author = "Alai Tan and Holmes, {Holly M.} and Kuo, {Yong Fang} and Mukaila Raji and James Goodwin",
year = "2015",
month = "2",
day = "1",
doi = "10.1093/gerona/glu072",
language = "English (US)",
volume = "70",
pages = "247--254",
journal = "Journals of Gerontology - Series A Biological Sciences and Medical Sciences",
issn = "1079-5006",
publisher = "Oxford University Press",
number = "2",

}

TY - JOUR

T1 - Coadministration of co-trimoxazole with sulfonylureas

T2 - Hypoglycemia events and pattern of use

AU - Tan, Alai

AU - Holmes, Holly M.

AU - Kuo, Yong Fang

AU - Raji, Mukaila

AU - Goodwin, James

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background. Coadministration of co-trimoxazole with sulfonylureas is reported to increase the risk of hypoglycemia. Methods. We identified a cohort of Medicare beneficiaries aged 66 years or older who took glyburide or glipizide for diabetes from a 5% national sample of Medicare Part D claims data in 2008 (n = 34,239). We tracked each participant's claims during 2008-2010 for a co-trimoxazole prescription and subsequent emergency room visits for hypoglycemia. Descriptive statistics and logistic regression modeling were used to evaluate hypoglycemia-related emergency room visits after coadministration of co-trimoxazole with sulfonylureas and its utilization patterns in older adults with diabetes. Results. Sulfonylureas users prescribed co-trimoxazole had a significant higher risk of emergency room visits for hypoglycemia, compared with those prescribed noninteracting antibiotics (odds ratio = 3.89, 95% confidence interval = 2.29-6.60 for glipizide and odds ratio = 3.78, 95% confidence interval = 1.81-7.90 for glyburide with co-trimoxazole, using amoxicillin as the reference). Co-trimoxazole was prescribed to 16.9% of those taking glyburide or glipizide during 2008-2010, varying from 4.0% to 35.9% across U.S. hospital referral regions. Patients with polypharmacy and with more prescribers were more likely to receive co-trimoxazole. Patients with an identifiable primary care physician had 20% lower odds of receiving a co-trimoxazole prescription. Hospital referral regions with more PCPs had lower rates of coadministration of the two drugs (r = -.26, p < 0.001). Conclusions. Coadministration of co-trimoxazole with sulfonylureas is associated with increased risk of hypoglycemia, compared with noninteracting antibiotics. Such coadministration is prevalent among older diabetic patients in the United States, especially in patients without an identifiable primary care physician.

AB - Background. Coadministration of co-trimoxazole with sulfonylureas is reported to increase the risk of hypoglycemia. Methods. We identified a cohort of Medicare beneficiaries aged 66 years or older who took glyburide or glipizide for diabetes from a 5% national sample of Medicare Part D claims data in 2008 (n = 34,239). We tracked each participant's claims during 2008-2010 for a co-trimoxazole prescription and subsequent emergency room visits for hypoglycemia. Descriptive statistics and logistic regression modeling were used to evaluate hypoglycemia-related emergency room visits after coadministration of co-trimoxazole with sulfonylureas and its utilization patterns in older adults with diabetes. Results. Sulfonylureas users prescribed co-trimoxazole had a significant higher risk of emergency room visits for hypoglycemia, compared with those prescribed noninteracting antibiotics (odds ratio = 3.89, 95% confidence interval = 2.29-6.60 for glipizide and odds ratio = 3.78, 95% confidence interval = 1.81-7.90 for glyburide with co-trimoxazole, using amoxicillin as the reference). Co-trimoxazole was prescribed to 16.9% of those taking glyburide or glipizide during 2008-2010, varying from 4.0% to 35.9% across U.S. hospital referral regions. Patients with polypharmacy and with more prescribers were more likely to receive co-trimoxazole. Patients with an identifiable primary care physician had 20% lower odds of receiving a co-trimoxazole prescription. Hospital referral regions with more PCPs had lower rates of coadministration of the two drugs (r = -.26, p < 0.001). Conclusions. Coadministration of co-trimoxazole with sulfonylureas is associated with increased risk of hypoglycemia, compared with noninteracting antibiotics. Such coadministration is prevalent among older diabetic patients in the United States, especially in patients without an identifiable primary care physician.

KW - Diabetes

KW - Drug-drug interaction

KW - Hypoglycemia

KW - Medicare

KW - Older adults

UR - http://www.scopus.com/inward/record.url?scp=84922464669&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84922464669&partnerID=8YFLogxK

U2 - 10.1093/gerona/glu072

DO - 10.1093/gerona/glu072

M3 - Article

C2 - 24858839

AN - SCOPUS:84922464669

VL - 70

SP - 247

EP - 254

JO - Journals of Gerontology - Series A Biological Sciences and Medical Sciences

JF - Journals of Gerontology - Series A Biological Sciences and Medical Sciences

SN - 1079-5006

IS - 2

ER -